Arterial Properties and Ventricular-Arterial Interactions in Severe Aortic Stenosis: Impact on Prognosis.

IF 3.2 3区 医学 Q2 PERIPHERAL VASCULAR DISEASE
Edward R Horton, Bryce V Johnson, Mahesh Vidula, Jonathan J Lee, Soumya Kondaveeti, Caroline A Magro, Srivinas Denduluri, Patrick Segers, Howard C Herrmann, Julio A Chirinos
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引用次数: 0

Abstract

Background: Systemic arterial properties contribute to clinical heterogeneity and outcomes in degenerative calcific aortic stenosis (AS). Lumped parameters of afterload have previously been associated with adverse left ventricular remodeling, mortality, and poor exercise tolerance in this population, but most studies did not assess pulsatile aortic pressure-flow relations, the gold standard method for assessing arterial load. Moreover, arterial compliance is highly dependent on non-pulsatile (mean) arterial pressure, which influences prognosis in this population.

Methods: We retrospectively studied 135 patients with severe AS with same-day catheterization and echocardiogram. Invasive aortic pressures and echocardiographic flow waveforms were used to assess pressure-flow and pressure-volume relations using Windkessel modeling and wave separation analyses. We used Cox regression to assess the relationship between pulsatile load and time to death and heart failure hospital admission (DHFA).

Results: Total arterial compliance accounting for pressure-dependence (PD-TAC) was independently predictive of all-cause mortality (HR=0.80, 95%CI=0.66-0.97; p=0.023) and DHFA (HR=0.70; 95%CI=0.50-0.97; p=0.031) even after adjustment for age, race, gender, BMI, and comorbidities, while other arterial parameters were not.

Conclusions: In patients with severe AS, pressure-dependent arterial compliance predicts adverse outcomes, while traditional pulsatile arterial load measures do not. Our findings suggest that methods accounting for pressure load on the arterial wall are advantageous in this population in which lower mean pressure can result from severe stenosis and ventricular dysfunction.

重度主动脉瓣狭窄的动脉特性和心室-动脉相互作用:对预后的影响。
背景:全身动脉特性导致了退行性钙化性主动脉瓣狭窄(AS)的临床异质性和预后。在这一人群中,后负荷的整块参数曾与不良的左心室重塑、死亡率和运动耐受性差有关,但大多数研究并未评估搏动性主动脉压力-流量关系,而这是评估动脉负荷的金标准方法。此外,动脉顺应性在很大程度上取决于非搏动性(平均)动脉压,这影响了该人群的预后:我们对 135 例重度 AS 患者进行了回顾性研究,患者均接受了当天的心导管检查和超声心动图检查。我们利用有创主动脉压和超声心动图血流波形,通过 Windkessel 建模和波形分离分析来评估压力-血流和压力-容积关系。我们使用 Cox 回归评估了搏动负荷与死亡时间和心力衰竭入院时间(DHFA)之间的关系:结果:即使在调整了年龄、种族、性别、体重指数和合并症后,压力依赖性总动脉顺应性(PD-TAC)仍能独立预测全因死亡率(HR=0.80,95%CI=0.66-0.97;P=0.023)和DHFA(HR=0.70;95%CI=0.50-0.97;P=0.031),而其他动脉参数则不能:结论:在重度强直性脊柱炎患者中,压力依赖性动脉顺应性可预测不良预后,而传统的搏动性动脉负荷测量则不能。我们的研究结果表明,在严重狭窄和心室功能障碍可能导致平均压力降低的人群中,考虑动脉壁压力负荷的方法具有优势。
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来源期刊
American Journal of Hypertension
American Journal of Hypertension 医学-外周血管病
CiteScore
6.90
自引率
6.20%
发文量
144
审稿时长
3-8 weeks
期刊介绍: The American Journal of Hypertension is a monthly, peer-reviewed journal that provides a forum for scientific inquiry of the highest standards in the field of hypertension and related cardiovascular disease. The journal publishes high-quality original research and review articles on basic sciences, molecular biology, clinical and experimental hypertension, cardiology, epidemiology, pediatric hypertension, endocrinology, neurophysiology, and nephrology.
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